Diabetes management for the most part involves blood sugar management, and this isn't unusual since high blood sugar is not only a symptom of diabetes, it's generally how the disease itself is defined.
So with type 1 diabetics, the goal is to replace the insulin that the pancreas would be secreting normally if it were working properly. We don't tend to pay attention to how much it should be secreting though, even though it's standard practice in hormone replacement to monitor hormone levels and look to restore them to proper levels, and only look to do that.
That's not the way we approach insulin levels though and insulin is actually the only hormone we look to replace with no regard to restoring proper levels. What we do instead is measure the proper dosing by just looking at blood sugar levels.
There are other factors in type 1 diabetes besides lack of insulin though, for instance type 1's generally have at least some insulin resistance, as well as issues with higher than desirable levels of glucagon, the hormone that opposes insulin, although not to the degree that type 2 diabetics get.
When it comes to type 2 diabetes especially, what we do need to really bear in mind that we essentially evolved toward a diabetic state by secreting too much insulin in the body's attempt to normalize blood sugar, so it is certainly not necessarily desirable to just look to dose insulin to normalize blood sugar because when we do that we may be improving blood sugar temporarily but worsening the diabetes, the tendency toward high blood sugar, the glucose intolerance in other words.
This is exactly what happens on the road to diabetes, you start out with high insulin levels, then insulin resistance worsens over time, including both liver insulin resistance and alpha cell insulin resistance, the cells in the pancreas that secrete glucagon, and over time you end up with less insulin sensitivity overall, and more and more glucose being secreted inappropriately by the liver, and the kidneys as well.
So we want to, at the very least, be careful with how we approach this, lest we worsen our diabetes by our methods to treat it. It's unusual for people to even get their insulin levels tested though, even if you are on it, and this is pretty stupid to be honest.
There's another concern here though, and this is one that few people have even considered. Extra sugar in your blood isn't the problem here, it's too much glucose in the cells that does the damage. The whole point of managing high blood sugar though is to prevent damage, but if there's too much sugar in the blood and we just look to sweep it under the rug by forcing it into our cells more, with more insulin, well you would think that would at least be a concern, especially since we require higher and higher amounts of insulin to do the job over time.
However, as this happens, our weight tends to go up as well, as insulin is the storage hormone, and adding pounds to diabetics is certainly something we need to be concerning ourselves with as well. The more overweight you are, the more saturated your fat cells get, and the more insulin resistant you get generally, because you are forcing the body to store more and it doesn't want to.
The prevailing view though is that, as diabetics, we don't get enough glucose in our cells and so we need to help with that, and insulin does help with that. However, if this were true, we'd have even less damage from blood sugar than non diabetics, because if less glucose were getting into our cells that would be the case, and damage is caused by too much, and it certainly isn't caused by not enough.
The idea that we don't get enough probably comes from the fact that you can feed two people the same diet and if one has high blood sugar and the other doesn't, the one with the high blood sugar, the diabetic, must not be absorbing this glucose from the diet properly, right?
The mistake here though is thinking that our diet is the only source of our blood glucose, and we know that with diabetics, they may even be getting more glucose from their liver than with even a high carb diet.
So with untreated diabetes, there's too much sugar being put into the bloodstream by both the diet and the liver, and too much ends up getting into the cells from this, and we can have too much and have high blood sugar as well.
I do want to point out though that I do think that insulin therapy has its place, and when used properly, especially when patients aren't actually secreting enough, it can be helpful and even completely necessary. We just need to pay more attention to how we use it and also be aware of the consequences of not using it wisely enough, particularly when it is used in such a way as to promote too much additional insulin resistance, inflammation, and obesity.
Insulin therapy does help reduce liver dumping though to some degree and that's the main benefit of it, and in doing this it does reduce the amount of glucose being put into the blood in the first place, especially in conjunction with other therapies, especially dietary restriction, and reduce microvascular complications that way, but this must be used with care to say the least, as we can overdo this for sure, as studies have proven, where people have ended up with lower blood sugar but a reduced lifespan.
Its benefits aren't from taking sugar out of the blood though and that's the dark side of insulin therapy actually, but we've come to understand that at least enough to now focus on some other medications and therapies that actually look to prevent too much sugar being put in the blood in the first place.
So the solution has to be to focus even more on having less glucose put in our blood , and therefore we will have less, a more normal amount, to have to deal with. So let's try to keep the floor cleaner, not just let the dirt pile up and then try to sweep it under the rug.